Internship Position Request

Admin Use Only

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Please note, if you have not already identified a student for your internship, several fields within this form will be published for prospective interns to review. These fields are noted by ALL CAPS below. Please visit Internship Announcements for additional details.

Department Information

NAME OF PRISMA HEALTH DEPARTMENT *

Supervisor First Name *

Supervisor Last Name *

Supervisor Phone Number

Supervisor Email Address *

Time/Location of Internship

ANTICIPATED FREQUENCY OF INTERNSHIP *

Potentially each Fall Semester

Potentially each Spring Semester

Potentially each Summer

As students express an interest

Rarely anticipate hosting interns

ESTIMATED TOTAL HOURS OF INTERNSHIP

PREFERRED DAYS OF THE WEEK

PREFERRED HOURS

About Your Intern

NUMBER OF INTERNS YOU’RE REQUESTING *

Have you already identified student(s) for this internship?

Yes

If you have already identified the student(s), please provide their email address:

Students will be emailed an enrollment form which captures the necessary data to initiate the GHS Student Services clearance process.

WHAT TYPE OF EDUCATION PROGRAM MUST THE STUDENT BE ENROLLED IN FOR THIS INTERNSHIP?

Associate’s degree

Bachelor’s degree

Master’s degree

Doctoral/PhD Program

PREFERRED DEGREE PROGRAM OF INTERN

Mission/Purpose of Internship

SUMMARY OF INTERNSHIP POSITION *

How The Intern Benefits

LEARNING OUTCOMES *

NOTES TO APPLICANTS

Will the student be required to be on a Prisma Health campus or is the internship completely virtual (off site)? *

Yes, the student will be on campus

No, the student will never be on-site

IS THIS INTERNSHIP FOR ACADEMIC CREDIT? *

Yes

Not Sure

WILL THE STUDENT NEED CITI TRAINING?

Yes

CITI training is often required of students that will be participating in formal research.

WILL THE DEPARTMENT OFFER A STIPEND?

Yes

Items you wish the student to submit when applying:

Please review all areas before you submit. If any changes need to be made or if you need assistance, please contact Student Affairs at Student.Affairs@PrismaHealth.org.

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(for Prisma Health Department use only)